An in vitro study comparing limited to full cementation of polyethylene glenoid components
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RESEARCH ARTICLE
Open Access
An in vitro study comparing limited to full cementation of polyethylene glenoid components R. Andrew Glennie1, Joshua W. Giles2, James A. Johnson2, George S. Athwal2 and Kenneth J. Faber2*
Abstract Background: Glenoid component survival is critical to good long-term outcomes in total shoulder arthroplasty. Optimizing the fixation environment is paramount. The purpose of this study was to compare two glenoid cementing techniques for fixation in total shoulder arthroplasty. Methods: Sixteen cadaveric specimens were randomized to receive peg-only cementation (CPEG) or full back-side cementation (CBACK). Physiological cyclic loading was performed and implant displacement was recorded using an optical tracking system. The cement mantle was examined with micro-computed tomography before and after cyclic loading. Results: Significantly greater implant displacement away from the inferior portion of the glenoid was observed in the peg cementation group when compared to the fully cemented group during the physiological loading. The displacement was greatest at the beginning of the loading protocol and persisted at a diminished rate during the remainder of the loading protocol. Micro-CT scanning demonstrated that the cement mantle remained intact in both groups and that three specimens in the CBACK group demonstrated microfracturing in one area only. Discussion: Displacement of the CPEG implants away from the inferior subchondral bone may represent a suboptimal condition for long-term implant survival. Cement around the back of the implant is suggested to improve initial stability of all polyethylene glenoid implants. Clinical relevance: Full cementation provides greater implant stability when compared to limited cementation techniques for insertion of glenoid implants. Loading characteristics are more favorable when cement is placed along the entire back of the implant contacting the subchondral bone.
Introduction Glenoid component loosening is a common cause of failed total shoulder arthroplasty (TSA) [1, 2]. Multiple studies have identified factors associated with glenoid component failure including glenohumeral mismatch, glenohumeral instability, excessive glenoid reaming at the time of surgery, cementing techniques, malalignment of the glenoid component, and osteopenic host bone [1, 3]. Although different methods of glenoid fixation are available, clinical and biomechanical studies would suggest that all polyethylene-cemented implants may have * Correspondence: [email protected] 2 Division of Orthopedics, Western University, 268 Grosvenor St, London N6A 4L6, ON, Canada Full list of author information is available at the end of the article
better initial in vitro stability and superior mid- and longterm clinical survivorship when compared to metalbacked implants [4–7]. Polyethylene glenoid prostheses can be broadly categorized as either “keeled” or “pegged.” Currently, the cement mantle required for adequate initial fixation and durable long-term survivorship of polyethylene prostheses is no
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